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Weekly UpdatesThe aging of the U.S. population presents a challenge to American hospitals and health systems. Not only are patients aging, but their care needs are becoming more complex as well. Compounding the problem is that many physicians are reaching retirement age, and their younger contemporaries (those born on or after 1965) tend to have a different approach to medical practice, valuing a work-life balance.
In 2005, approximately 900,000 physicians were practicing, and of this number 36 percent were at least 55 years old and nearly 170,000 were at least 65 years old (Runy 2008). The Office of Inspector General has cited physician scarcities in various specialties, including obstetrics, family practice, general surgery, neurosurgery, orthopedics, urology, otolaryngology, cardiology, gastroenterology, neurology, and oncology. Cooper (2008, 13) predicted a 20 percent physician shortage within the next two decades, the effect of which may be especially detrimental to rural hospitals. According to a 2007 Merritt Hawkins survey, the average net inpatient and outpatient revenue generated by physicians varied from $1.43 million (family practice) to $2.66 million (invasive cardiology).
A healthcare organization's ability to recruit and retain physicians affects its ability to deliver mission-critical care to its community. Limited physician supply and growing demand for their services, coupled with multifaceted process requirements, can make physician recruiting seem like a house of cards, which is painstaking to construct and can be destroyed by a single careless remark or an improperly executed process. In this column, we discuss field-tested strategies for improving physician recruitment and contracting.
RECRUITING STRATEGIES
Get the CEO Involved
Clearly, the CEO must play a role in physician recruiting. He or she must maintain the organization's focus on this effort despite the presence of competing priorities. The CEO should do the following:
* Meet with the recruiting team, including physician champions, at least once every quarter to monitor progress and to offer guidance and resources.
* Participate in developing recruitment and marketing initiatives.
* Interview (even briefly) all promising candidates.
* Support the recruitment team's recommended financial incentives for physicians.
* Hold leaders accountable for physician recruitment and retention by tying their compensation and advancement to organizational performance.
* Request the recruiting team to brief promising candidates before they meet with certain abrasive personalities on the medical staff.
Develop Compelling Marketing Materials and Programs
Standing out in a crowded field is difficult, so the organization's marketing and recruiting teams should pair up to strengthen the recruiting initiative. Compelling marketing materials underscore organizational values and assist in attracting applicants who will fit the culture. Applicable marketing techniques may include the following:
* Encourage physicians and employees to notify the recruiting team of any students from the community who are in pre-med programs, in medical school or in residency and who are looking to return to their hometown. A similar request may be extended to physician spouses as well.
* Sponsor a guest speaker and invite the community to the event. This approach promotes the organization as a good neighbor and as a great employer. In addition, this activity can build a bridge between the organization and the community while offering continuing education credits to medical students and residents.
* Publicize the benefits of working at the organization (e.g., the location's school system is one of the highest rated in the country, medical research and innovation are top priority, the hospital follows a healthy environment model rather than merely state its operational features (e.g., Level 2 trauma center, 1,500 employees, $200 million in revenues).
Provide Appropriate Financial Incentives
Using a community needs assessment that demonstrates a shortage in a specific physician category has allowed organizations to offer the following incentives (please consult with a healthcare attorney first to ensure that these incentives comply with local, state, and federal regulations):
* Reimbursement of travel (incurred because of interviews) and moving expenses
* Assistance with the legal fees associated with obtaining work visas (for foreign physicians)
* Loans (which may be forgiven over a certain amount of time) for repaying medical school debt or starting a practice
* Income guarantees for the first two years of practice in the community
* Compensation for taking emergency department calls (e.g., direct payment, deferred compensation, malpractice premium assistance)
The Executive Compensation Compliance Initiative of the Internal Revenue Service (IRS) requires not-for-profit organizations to meet fair-market guidelines for reasonableness of compensation. IRS rules and other healthcare regulations are complex and change frequently. Thus, the recruitment team should consult an experienced healthcare attorney to develop a fair, robust, and legal compensation and incentive program.
Stay Current with Technological Advances
Web 2.0, the second generation of Internet design that enables sharing and communication among Web users, enables the organization to update its website to allow people to interact with its programs and services. For recruiting purposes, the following are some of the functions that job candidates may find on an organization's website:
* Dedicated recruitment web page, with links to other topics or sites of interests
* Job search feature organized by specialty and location
* Direct contact with the recruiter
* Capability for online application
* Video clips, virtual tours, and maps of the facility and the community
* Audio testimonials from recent recruits and long-term physicians and their spouses
Another technological strategy is to produce a recruitment CD or DVD that is both informational and promotional. Delighted physicians, employees, spouses, and even patients may be asked to appear in this video. Some organizations also use networking sites, such as LinkedIn and Facebook, to reach out to potential candidates.
Here are a few websites that provide job listings for physicians and search opportunities for recruiters:
* practicelink.com
* physicianwork.com
* docjobs.com
* aspr.org
* nejmjobs.org
* Job boards of various physician professional associations, by specialty, such as www.aafp.org, www4.aaos.org, www.acc.org, and www.acr.org
Make the Interview Process Memorable
The interview process is the organization's chance to exceed expectations and differentiate itself from the competition. For this reason, the interview process must be planned well in advance, ensuring that the experience is favorable before, during, and after the process. Following are details to keep in mind when establishing the interview process:
* Form a core group of interviewers. The number of interviewers will vary depending on the number of recruits and physician interest. The group should include a mixture of specialists and generalists, and at least one member should have similar background and training as the candidate being interviewed. Also, the group should include a physician who can influence a candidate to take the position. If possible, mitigate the effect of an interviewer who is not enthusiastic about his or her association with the organization by bracketing this person with enthusiastic interviewers and letting the candidate know about this person's attitude beforehand.
* Script the interview process. Each interviewer must be trained to ask and answer questions and to fairly assess the candidates. Each interviewer should be assigned a focus topic, such as clinical competence and education, interpersonal skills and practice style, and knowledge of and experience in the healthcare business.
* Structure the interview. Interview questions should be developed in advance, and these questions must be asked of all candidates, with minor adjustments for differing specialties. Interviewers must have the newest copy of an applicant's resume, credentials, references, and other related paperwork. Also, the sequence of which interviewer should go first, middle, or last has to be plotted. For example, beginning and ending the process with the CEO, COO, or CMO sends the message that the applicant's service is valued.
* Plan the logistics of the visit. When the candidate comes from out of town, the organization should extend its hospitality by making arrangements for the visit, which leaves a great first impression. Expenses for travel, hotel, restaurants, and car rental should be billed directly to the organization to bypass a lengthy reimbursement process. An invited realtor should speak about the history, services, and benefits of living in the community and surrounding areas rather than try to sell the candidate on a house. A gift basket sent to the candidate's hotel room provides a welcoming gesture, enhancing the first impression.
* Offer a spouse or family activity, if applicable, while the candidate attends the interviews. Lunch with other physician spouses and/or a community tour can provide useful information and networking opportunities. The group in charge of this task may be composed of public relations staff, physicians, spouses (both male and female), and managers who are reliable and enjoy reaching out to others.
Carefully Execute the Job Offer
Timeliness and precision in executing the offer are essential. The following are some details that deserve attention and careful execution:
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